ICU CASE MIX: THE TIMES THEY ARE A CHANGIN'

THEMATIC SESSION

Chairs Hans Flaatten (Bergen, Norway) and Andreas Valentin (Schwarzach, Austria) guide this session which will highlight the gradual change in the patient populations admitted to the intensive care units worldwide. Not only has the demand for intensive care increased, but new groups of patients previously not considered the norm for intensive care, have now become routine visitors. The impedus behind this transition is partly due to evidence that the results from these patients are often encouraging, such as with very old patients, who can benefit from new therapeutic options now available for advanced care, like for severe kyphoscoliosis and advanced cancer therapies, which make intensive care worthwhile.

The following presentations zero in on key patient groups which offer unique care challenges:

Obese patients    

Obesity is a "pandemic" and a significant proportion of adults in developed countries today have an BMI > 30. This also means we frequently see those patients in the ICU. Although not intuitive, but obesity up to a limit (BMI >35-40) seems to be protective with regard to survival after intensive care. This session will briefly discuss the various problems severe obesity may have for the ICU team and suggest how best to manage these challenges.  

~Hans Flaatten (Bergen, Norway)   

Physically disabled patients   

Two key factors: changing demographics and medical progress will affect the case-mix of adult intensive care units. While it is acknowledged that capacity in critical care services will be challenged by an ageing population, there are other issues at play, such as reclassification and/or rebranding of disease which will increase demand for care for patients with terminal organ failure. Similarly, new therapies for previously fatal disorders (e.g. cancer) will increase demand. This presentation will centre on one group of patients: those with severe disability, who may suffer from a variety of conditions that were historically treated in a paediatric environment and who now are often treated in adult ICUs. This change may represent a challenge to current ethics standards these ICUs.

~Jon Laake (Oslo, Norway)

ICU patients with advanced malignancies   

Advances in cancer treatments mean more people than ever are living with and surviving cancer. Currently, one in 16 patients with cancer require ICU admission, but as we push the boundaries of cancer therapies this number is likely to increase. As ICU clinicians we need to carefully consider the burden of risks and benefits of ICU therapy for our patients, in particular those with progressive disease, the impact on short and long-term quality of life and the associated costs. Part of this involves individualised patient care, but also includes advanced care planning for patients with progressive disease and good quality transition to end of life care for patients who fail to improve despite a trial of ICU therapy.

~Pascale Gruber (London, United Kingdom)   

Frequent flyers   

One of the greatest changes in the practice of intensive care medicine is the change in the population of the patients that we now treat. They are older with multiple chronic conditions, which are not curable or reversible. Many are near the end of life and have not been recognised as such. As intensivists we can easily recognise and treat an acute condition such as a fall or infection. However, the next step is to see the acute condition in the context of the overall prognosis of the patient. Even when we do treat patients successfully, many of these elderly frail patients die within 12 months from age-related chronic conditions. Many, when given the choice, do not necessarily want to be admitted to hospital when they are near the end of life. As a specialty we need to consider the implications of treating the elderly in intensive care units.

QUESTIONS THAT WILL BE COVERED IN THIS PRESENTATION:
-How do we accurately recognise elderly patients who may have less than 12 months to live?
-How do we manage the elderly frail who are near the end of life?
-What sort of research is now needed in view of the change in the population of patients in ICU?

~Ken Hillman (Sydney, Australia)   

Refugees    

This presentation will focus on the recent refugee crisis experienced across Europe. The organisation and medical care of refugees on their way through Austria posed an enormous challenge to the healthcare system. In the pre-hospital setting, measures to protect in case of a major incident had to be taken. The majority of pre-hospital emergency car responses and emergency department visits were due to non-life threatening acute or chronic medical conditions. Few patients had to be treated in the ICU. This was mostly due to exacerbation of chronic medical conditions (e.g. heart failure), sepsis (e.g. pneumonia), after surgery or rare conditions (e.g. tuberculosis or tick borne relapsing fever).

~Martin Dünser (London, United Kingdom)

ALSO in this session:

Impact of the working climate on the case-mix        
Dominique Benoit (Ghent, Belgium)
   

THEMATIC SESSION ~ ICU CASE MIX: THE TIMES THEY ARE A CHANGIN'

05.10.2016, 12:00 – 14:00, room Paris      

#outcomes